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Hip Injuries in Athletes Focus on Femoroacetabular Impingement (FAI) Ian Rice MD

Learn about pathoanatomy, clinical diagnosis, diagnostic imaging, hip arthroscopy basics, and evidence-based medicine for FAI. Discover prevention strategies and key take-away points in managing hip injuries in athletes.

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Hip Injuries in Athletes Focus on Femoroacetabular Impingement (FAI) Ian Rice MD

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  1. Hip Injuries in Athletes Focus on Femoroacetabular Impingement (FAI) Ian Rice MD Sports Medicine Orthopedic Surgeon TriHealth Orthopedic and Sports Institute

  2. Overview of Femoroacetabular Impingement (FAI) and related hip conditions • Pathoanatomy • Clinical Diagnosis • Diagnostic Imaging • Hip Arthroscopy Basics • Evidence-Based Medicine for Hip Arthroscopy • Prevention • Take-Away Points

  3. Pathoanatomy

  4. Impingement with hip flexion Shear forces on cartilage at chondrolabral junction Subtle findings on MRI: marcainearthrogram with traction, 1.5+ T MRI

  5. CAM PINCER

  6. Prevalence/Incidence Overall 10-fold increase risk of alpha angle >55 deg in athletes vs normal population! • 37% Asymptomatic CAM Deformity • 54% in athletes compared to 23% in normal population • 67% Asymptomatic Pincer Deformity • 94% NFL combine athletes with previous history groin/hip pain

  7. Wolff’s law: Bone will adapt to the loads placed on it

  8. Examination/Clinical Diagnosis

  9. Unrealistic

  10. Focus on this Rule Out Other Causes • Have patient sit up and palpate anterior groin/inguinal canal • Sig pain suggestive of sports hernia or peritoneal causes • Test resisted adduction • Adductor (groin) muscle strain or tear • Also palpate adductor origination at pubis • LE Neuro Exam, Straight leg raise • Radiculopathy, referred lumbar spondylosis pain FADDIR

  11. CoxaSaltans External Internal Iliopsoas snaps on femoral head or iliopectineal eminence May be associated with FAI Also associated with Iliac Spine avulsion injuries and malunion • Snapping IT Band • Most common • Flexion  Extension or rotation

  12. Apophyseal Avulsions • Iliopsoas avulsions from ASIS (origin) or lesser trochanter (insertion) • Rectus Femoris avulsions from AIIS • Hamstring avulsions from ischial tuberosity • Adductor avulsions from pubic rami • “Post-traumatic” FAI = Subspine Impingement

  13. Radiographic Indicators of FAI

  14. Center Edge Angle (Normal 25-39, <15 = dysplasia) Alpha angle (Normal <50 deg) Crossover sign

  15. Standard Views I recommend AP and Frog Leg views

  16. Hip Arthroscopy

  17. Abductor Tears The Rotator Cuff of the Hip Coaches, Active Parents, Teachers, and other active adults (typically >50s)

  18. Abductor Anatomy

  19. Abductor repair surgery

  20. Where is the evidence?

  21. Prevention

  22. The hip dictates knee landing mechanics and rotational forces • Weak hip external rotation increased odds of ACL injury 23% • Weak abduction increased odds of ACL injury 12%

  23. 72% reduction in hamstring injuries during season vs control • 579 athletes

  24. Take-Home Points • Student athlete with anterior groin pain, clicking/catching like knee meniscus • Think Hip Labral Tear • Reduced hip ROM (especially decreased internal rotation) in young athlete • Think FAI • If your doctor orders an MRI, encourage marcainearthrogram study with traction • Best sensitivity for labral tear, and diagnostic for intraarticular pain origin • Refer to a hip arthroscopistif clinical concern for FAI/labral tear, verified intra-articular pathology, or failure to improve with several months of activity modification/therapy • In patients >50 yowith recalcitrant “trochanteric bursitis,” consider abductor tear and referral to hip arthroscopist

  25. Ian Rice MD Contact Info Philosophy Treating every patient with the compassion and attention to detail I would provide my own family Athletes of all ages and skill deserve the same professional-level care received by the world’s best athletes I value accessibility and availability to both patients and colleagues, and believe the best outcomes result from a team-based approach to care • 513-346-1599, or 513-346-1500 • www.facebook.com/cincysportssurgeon

  26. Contact my assistant Dave Ahouse MA ATC directly at 513-346-1599 Office hours 5 days weekly including Saturday morning! Same day or next day appointment Office Locations Rookwood Clifton Group Health 379 Dixmyth AvenueCincinnati, OH 45220 • 4030 Smith Road, Suite 350Cincinnati, OH 45209Phone: 513 346 1500Fax: 513 872 7826 West Chester (Discovery Drive) • 7798 Discovery Drive, Suite AWest Chester, OH 45069 Surgery Locations at: Bethesda Surgery Center Evendale Hospital Bethesda North Hospital Good Samaritan Hospital

  27. Specialties • Hip: Hip Labral repair, FAI surgery, Arthroscopic Hip Abductor Repair • NEW to • Sorry! Not hip replacement • Shoulder: Rotator Cuff Repair, Labral Repair, Subpectoral Biceps Tenodesis, Shoulder Stabilization • Knee: Anatomic ACL Reconstruction, All-Inside Meniscus Repair, Cartilage Repair and Restoration, Patella Stabilization with MPFL Reconstruction • Elbow: Elbow Arthroscopy, UCL Reconstruction (Tommy John Procedure), Distal Biceps Repair

  28. Thank You

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